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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N°5 6 5 9 Date: 0/10 «.. ,r.W► Owner: _ _. R-— Builder Address Address �- T! F BUILDING i No. Street-� Part of Lot Lot '� Block ___ _ Addition or Sub -Division Corner Lot __ Inside Lot Setback Sideyard l� Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Front Depth Height Z�F— Sq. Ft. Cu. Ft. Est.. Cod# �"'""�_ _ To be Com leted In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. _ In consideration of the payment of a fee of , permit is hereby gram to to construct the building or addition as described' above. permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any, part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any upon°laati of the provisions of said ordinances. ✓/ P" Building Inspector i FNOTICE:rmit does not corer the construction, Installation for wriring, plumbing, gas heating, aa� aror water. Be sure to Seo lispector for separate permits for thOo items. City of Fridley, Minn. N? 8464 BUILDING PERMIT • Date: SEPTEMBER 17, 1965 Owner: MARENCE H. LARSON Builder _ _ SAME Address 10425 Xavier N.E. Address Coon Rapids, Minnesota LOCATION OF BUILDING No. 5519 Street 4th S t . N. E. _ Part of Lot Lot _ _ _ Block Addition or Sub -Division Corner Lot _ Inside Lot _ _ Setback __._ Sideyard Sewer Elevation ____— , Foundation Elevation To be Used as: Type of Construction DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Front Depth Height Sq. Ft. _ Est. Cost , 1 000 00 __ To be Completed • REPAIRS DUE TO STORM DAMAGE • Cu. Ft. Cu. Ft. In consideration. of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above set forth and in compliance with 21 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 10.00 ,permit is hereby granted to M ARENCEH_ LARSON to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTICE ab peredf does not corer the condrucdon, hidaMen for whtag, plumbing, gas heating, sewer or wda. Be sun to we the Building hnpeetor for wparde permhs for those Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME �� ,, , .� BUILDER �3 ADDRESS 1"d ADDRESS LOCATION OF BUILDING No,� j �- �= STREET `S PART OF LOT--Z-f. LOT BLOCK 6` ADDITION OR SUBDIVIS1014 CORNER LOT INSIDE LOT SETBACK SIDE YARD SEWER ELEVATION FOUNDATION ELEVATION_ . Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be used as; DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height —�> Sq. Ft. Cu. Ft. r Type of Construction To be completed Estimated Cost , a The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct, l - DATE SIGNATURE��/�a�✓,' (Schedule of Fee Costs can be found on the Reverse Side). susJEcr PE City of Fridley G 20264 AT THE TOP OF THE TWINS ? BUILDING PERMIT RE Ir %. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 1,`J NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 3/26/90 JOB ADDRESS 5519 -- 4th_ Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 28--30 6 Hamilton's Addn. to Mechanicsville SHEET 2 PROPERTY OWNER MAILADDRESSZIP PHONE Tanya Larson 5519 - 4th-Street N,E. 574-0845 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (12 Squares) 9 CHANGEOFUSEFROM TO STIPULATIONS Roof ¢ can be.2nd layer but not 3rd. Install ridged, galvanized valley TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $600 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $17.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. N CHECK FEE TOTALFEE 7 $17.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) HEN PROPERLY VALI ED THIS IS OUR PERM T 1 �-,)q-10 - ` BLDG NSP ozoi OXT E SIGNATURE OF WNERIFOW NER IL DEP) IDATEI NEW [ ] ADEN [ ] ALTER [ ] CITY OF FRIDLEY Effective 1/1/g0 R-1 AND R-2 Building Permit Application Legal Description: Owner Name & A 1 Ckntj a. L a c - ,O r\ 5S 19 L4 & S+- AJF TIP -1. # 5'N -O SS/5 Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed constriction drawn an it to scale. DFSCRI CN OF noROVEMM LIVM AREA: Length Width Height Sq. Ft. GAMM AM: Length Width Height Sq. Ft. DECK AREA: Width Hgt/Gro and Sq. Ft. 07MM: o �� D Corner Lot [ ] Inside [ ] Ft. Yd Setback Side Yard tbacks Type of Construction: r Estimated Cost: $C�� Approx. Canpletion Date: Proposers Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: APMCAW:�' Tel . # 5 7 </ -QFV,5 Permit Fee $ /'7 e C" (1 State Surcharge $ S� SAC Marge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ $ / `7• SO STIPULATIONS: CITY Un ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PERMIT '20 5 5 0 RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 612-571-3450 NUMBER 910-F15 REV GATE 9/4/90 PAGE OF APPROVED BY JOB ADDRESS 5519 - 4th. Street N.E. 1 LEGAL DESCR. LOT NO. 28-30 BLOCK 6 TRACT OR ADDITION SEE ATTACHED Hamiltons Addn. to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tanya Larson 5519 - 4th -Street N.E. 574-0845 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION Gj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install new windows - Reside House 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,000 $1.00 PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $45..00 PLAN CHECK FEE TOTAL FEE Fire SC $2,00 $48,00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WIjEN PROPERLY VA ATED THIS IS YOUR PERMIT BLDG INSP E SIGNATURE OF OWNER JF OWNER BUILDERI IDATEI 01 NEW [ ] Effective 8/16/90 ADEN [ ] 1-1 AND R-2 ALTER [ ] Building Permit Application A Construction Address: Legal Description: �� V �A�� g �i_, Tel #., 9�F Ownex Name &Address: C3. ! . ��^�� , ��, �, � ,,. Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVIM AREA: Length Width Height Sq. Ft. GNU= AREA: Length Width Height Sq. Ft. DECK AREA: Length Width /Ground Sq. Ft. OTHER: K) 0 C-1!/( L S Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks„ Type of Construction: Estimated Cost: $ , b 0 ,n Approx. Ccupletion Date: Proposed Driveway Width If New C)pezing Is Desired: Ft. n Width + 6' DATE: % L7 APPLICANT: See Back Page Tel. # ZCrM SI'IPULMIONS: 4 C 9s,�► CITY USE COY LIS, Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ 0,0( .001 x Permit Valuation (1/10th �) State Surcharge CO $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Neow-saiy [ ] ZCrM SI'IPULMIONS: 4 C 9s,�► Building MECHANICAL PermitNo.: R -biO3 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DatefOl SEP 30 2 763-502-4p7l FAX EFFECTIVE 1-1-08 /j Q DATE /011 / YOUR E- IL ADDRESS /" 4_ SITE ADDRESS 1 S l THIS APPLICANT IS: ❑ OWNER TRACTOR PROPERTY NAME: ADDRESS: i TY STAT IP OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME: CONTACT PERSON: NOTE: SEPARATE CITY STATE LICENSE # EXP DAT LICENSES ARE REQUIRED FOR GAS Y STA P AND HVAC.ADDRESS: SUBMIT COPY OF BOND PHONEC. / 7 = x/ —N IST FAX AND INSURANCE PERMIT TYPE GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW 1 IMPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) OR Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU MFG: MODEL: SIZEBTU $25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00 _A/C _FIREPLACE TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 _AIR $35.00 5ZIFURNACE $35.00°` _GAS UNIT HTR $10.00 _BOILER LINER $10.00 IL DRYER $10.00 POOL HEATER $35.00 _CHIMNEY _GAS WORK $10 00 PIPING $1000 VENTILATOR $15.00 _DUCT _GAS Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ �. OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and wor is of to start without a permit; that the work will be in a rd with e a ve a case of all work which requires review and approval of plans. PRINT NAM 1- c E SIGNATURE OF APPLICANT s APPROVED BY DATE rl0 < ,..,� W 5,.OR �. `.�. . ,, City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. From: 7634342860 Page: 2/5 Date: 10/3/2008 8:24:20 AM / a0� Suildi g _ PLUMBING • Inspections ISE IM NTLAL•"PUCA1iON Re— a 3Y: 763-572-3604 CT" OF LEY . D� Rec°d: �=,�- 763-502-4977 ]'AX ZFMCT s 1.144 /zm�A7iy v YOM 9-MAM ADDRM STM ADM& 77 � � MW • III TW lFry.X OWNUR Tp%�T6owrm ��r L' Rl II Pe'1►�7G � �y% F� AD�DLF�S;�-�iE. ,� ?!f► 5 /7/ ar 1 STA R�,-„� MANr Vl�fil 6- — Z—, COMAMP. X13_ syslS o1 YOUR . S'T'ATATE STA7S Llci M ��, 0 EVDATE 6 ad LICEMR, DOM AND cl11 SSTATE WND s�'&X IV DATA V -1- 0,1009, r> Ct C a�z s rrri� • . srar��,ar,�t c(y r_ G " FAX,..,_.. P31thm TYPE FAl14T N Q TWO FrilMILY D TOWNHCKM TY?R OF WOFJCJ 11N .» )AWLAM444* OF WORT: PU MS 16B.66S the PMTMI fee is a mimitmvm of $1 LDL or 5"/a of the IMI cost up to+%Q0.111M whichever is pwW, for the Uborirs�ptl��rt+eeet, in�iistipn �- tegta�sn�a1 c�br a. rbsidetx+3al fixt►�� exeludlog flue iix�ros. (This sirould rafie�. ogly rhe +Goat of labor } . twat under $300 - S15_QD. Labor act, t between 5300 to 5500 w can of i*r x .OS R -. -- – -- plus .50 swshloa OR X)R, PROEM WMMLABM EXCIMs V:X). FM AMU= ON S IMN M F19MIF.P. EXCEPT WISH NQM. F117URt;<S: (MCAIS TOTAL •Nti1 SIOL OF SA03'01:'W% UV404UM FO: _aarA stM(njiv FW:)R D Aryls _SHOVI . —WATER PIM10 _ 2A3V UB _ GA5 I?nnM (MD CrN U0 ; _ SV 8dNWG POOL — WATEP 50F n.GR MS) _ CLOTM WA5i1ER ., _ X 1:g19N MXK IVAiER CLOW — SA,CK.i W pMV- 0157 _1it5HWA5i,151t LAU,P RYTRAY ACCRA W51 t?TH6R 1GATION �..,r.�•..,o ?� NMUM ormi s (N 51Q.90 x 5]0.00 � Nmubtw orfs a $15.00x 515.00 OR 'Number •of fix[um @ S35.00 � ,, x MAO - • Sts .u[ �+ fRRiNiMtifuf M 4 4011 T e►nl � THIS C3: JV APPI.ICAT M FOR A "WM1T-N0rVAY4JD UNTIL PkOCESSED I haooby appl} for a plumbing permit acid i hcknawledV dot the inf,5tmsd" abn is eompiae hnd eccursft; that the work will be 0i todhi taut& with ft. n hmiam and exiles *,+ff the City offrldlCy rill wM t'ht: Nronrw34re. C4aruefian Codes; that I wide stand shin 13 Act A permit but only+ an opFlicadoa for s. pwmit and woitk is riot m start wiftut a pormit on situ that the lvm* will be hi umrdance will 1110 approved plan 16e *fall ,uaark which rupires revkw aad appra�) of plan. J _ City of Fridley . , �1I�d>u1g �Gspecfaio�s �op$.�eiat 64-31 Universky Aveaue NES Ridley, MN' 55432 763-572 3604 FAX: 7634402-4977 z000b SHd LS -09 2709/s0/90 Building BUILDING Permit N0. Inspections RESIDENTIAL APPLICATION Received By: /VW 763-572-3604 CITY OF FRIDLEY D ' 763-502-4977 FAX ttU EFFECTIVE 1-1-08 DATE �� 6 OO YOUR E-MAIL 06 SITE ADDRESS SS/! 'AADDRESS 2 J/. ME, re-, i%ey %n N THIS APPLICANT IS: KOWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: AG/"e�/ �l�.%t7 TENANT ADDRFCSS:sy/ 7 &14- sk. 4li CITY /C; -,rd STATEmyZIP PHONE: 6!Z " ZO 9 NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE ASINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING JKOTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR KREMODELING DESCRIBE WORK BEING DONE: l aLG rY'C� r(I SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit l . Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and t. proposed project ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS kes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: +SING THE 1997 UBC FEE SCHEDULE) �� TOTAL JOB VALUATION $ /, A OCCUPANCY TYPE Permit Fee $ i�'�/c�i� See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ ► .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ , Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Constructio Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in ar a ce ged plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME Q . oQ�_) DATE l® b APPROVED BY DATE Building $ ,21,5b BUILDING $ Permit No.Aq-CON 71 Inspections Surcharge RESIDENTIAL APPLICATION License Surcharge Received By: 763-572-3604 $ Curb Cut Escrow $ Erosion Control $ Park Fee CITY OF FRIDLEY Sewer Main Charge Date Rec'd: J 763-502-4977 FAX $ EFFECTIVE 1-1-09 DATE 3(710 -( YOUR E-MAIL ADDRES,S1 14 get f h . c v !M SITE ADDRESS _55 l �� 4 SJ THIS APPLICANT IS: OWNER ❑CONTRAC O PROPERTY OWNER/ NAME: - UL Atn t, Z.JG° J TENANT X14 ADDRESS: 5- J Z 9 > CITY 7Z,'D L f ''J STATEft_ZIP PHONE: _ (o / ,Z ' 2 C' Q - 2V CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILYINEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES_ PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ELWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION I+ �MAINTENANCE/REPAIR ❑ REMODELING 0 1J % L (�'�- DESCRIBE WORK BEING DONE: PLD j^/®44f) SIZE OF IMPROVEMENT LENGTH Z:ffi !i WIDTH HEIGHT ( (f SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES El HOUSE & GARAGE BASEMENT REMODELING SUBMIT: I . Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I . Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS )(Yes ❑No LOC4T10N OF W NDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF j' A OPENING CHANGES & ' TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE, BASEu ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION $ (USING THE 1997 U.B.0 FEE SCHEDULE) OCCUPANCY TYPE Permit Fee $ ,21,5b Plan Review $ Fire Surcharge $ Surcharge $ License Surcharge It SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of work whi h equires review and approval oflans. 22 SIGNATURE OF APPLICANT PRINT NAME,O?--ej— DATE Z